Changing synthetic drug formulas complicate treatment, rehabilitation

KUALA LUMPUR: The constantly changing chemical composition of synthetic drugs is making treatment and rehabilitation increasingly challenging, particularly during detoxification.

Illicit producers can alter drug formulas to evade detection, making it difficult for treatment providers to determine what users have consumed.

Detoxification must be carried out under close medical supervision and requires identifying the actual substances consumed, as each drug requires a different treatment approach.

The process aims to manage withdrawal symptoms such as vomiting, body aches, shivering, anxiety and sleep disturbances, which can, in severe cases, lead to seizures, dehydration or psychosis.

Persatuan Pengasih Malaysia (Pengasih) president Hafizi Harun said the biggest challenge was accurately identifying the substances users consumed, as the contents can differ even when sold in identical packaging.

He said some people seeking treatment claimed they had only used vape products, but there was no certainty whether the liquids contained etomidate, furanyl fentanyl, synthetic cannabinoids or other chemically modified substances.

"This information is important because different drugs can have different effects on the body and brain, and require specific treatment methods.

"For example, heroin users commonly experience withdrawal symptoms such as body aches, insomnia, watery eyes and nausea, while methamphetamine users are more likely to experience hallucinations, aggressive behaviour and psychosis during withdrawal.

"Similarly, if someone has used furanyl fentanyl, treatment workers must be prepared for the risk of overdose as it belongs to the highly potent synthetic opioid family," he said.

Universiti Malaya Centre for Addiction Sciences (UMCAS) Associate Professor Dr Rusdi Abd Rashid said detoxification, or the process of managing withdrawal as drugs leave the body, must be carried out safely to prevent medical and psychiatric complications.

He said the duration of detoxification depended on the substance used, level of dependence and actual contents of the drug, particularly synthetic drugs containing varying active ingredients.

"For fentanyl, detoxification is shorter than for heroin and morphine, which usually takes about a week, depending on the purity of the active ingredients in the drug mixture.

"Although the process is shorter, fentanyl withdrawal symptoms can be more severe, including prolonged seizures and psychosis, which may lead to psychiatric emergencies and suicide," he said.

Rusdi said fentanyl users might require close monitoring in a ward to ensure that withdrawal was managed safely.

"Severe withdrawal symptoms not only cause discomfort to patients but can also lead to serious complications such as brain injury, aspiration pneumonia and hypoxia, or oxygen deprivation," he said.

However, Rusdi stressed that his explanation on detoxification applied specifically to fentanyl and did not cover stimulant-type synthetic drugs such as methamphetamine or syabu.

He said fentanyl was an opioid with effects similar to heroin and morphine but was significantly more potent and acted faster, increasing the risk of dependence and addiction.

"It can also cause more severe cravings, including prolonged seizures and death," he said.

He said early signs of fentanyl dependence included increasing the dosage to achieve the same effect, experiencing withdrawal symptoms when attempting to stop or reduce consumption, impaired daily functioning and loss of control over drug use.

"Such individuals may no longer be able to stop without undergoing detoxification with the assistance of suitable substitute medication," he said.

Rusdi said there were so far no genuinely verified cases, based on scientific evidence and clinical observations, of fentanyl users being brought to clinics or hospitals or admitted to the psychiatric ward at Universiti Malaya Medical Centre.

He also said he had not received official reports from the National Anti-Drug Agency (NADA) or police on the number of fentanyl-related arrests, while reports circulating on social media had yet to be verified.

He called for prevention programmes and health education on the dangers of fentanyl to be expanded, particularly in schools and higher education institutions.

Rusdi also urged the government to raise public awareness of the drug's dangers and encourage users to seek medical assistance to stop taking it safely.

At the same time, he said enforcement agencies should focus on curbing the sale and distribution of drugs, while treatment should be handled by healthcare facilities with the relevant medical expertise.

"Police and NADA should not focus on arresting users or addicts as this may make them afraid to seek treatment.

"Treatment should be entrusted to healthcare facilities to ensure their safety when they want to stop, as NADA do not have doctors trained in this field," he said.